A patient enters my office in a bout of depression and in need of counselling—if only comprehensive mental health care were included in Canadian medicare. The next patient, a newcomer to Toronto in need of housing, has moved here fleeing persecution abroad, only to face homelessness and a decade-long waiting list for housing. Another ends up in the emergency department with excruciating pain from a dental abscess, a complication easily prevented with routine dental care. One neighbourhood away, a patient needs HIV prevention treatment, but is told at the pharmacy that it will cost him hundreds of dollars per month so he goes without. A few streets over, someone dies of an opioid overdose alone in their home, because of a contaminated drug supply, and lack of access to an overdose prevention site.
These scenarios are ones that, as health care providers, we are all to familiar with. More broadly, though, they’re illustrative of the realities facing many Canadians—realities so commonplace that health and healthcare consistently rank as top priorities for voters during election season.¹ Despite voter interest, the 2019 federal election campaign has been all but devoid of discussions on health policy, to the point where the marquee English language debate on October 7 did not even dedicate one of its five themes to health.
Ahead of Monday’s election, we wanted to take some time to consider how this election could shape our health care system and alleviate, or exacerbate, the scenarios described above.
If health is such an important responsibility of government, what policies should be implemented to ensure the health and happiness of Canadians? First we have to discuss what shapes health outcomes. 25% of health outcomes are dictated by a person’s interactions with the health care system: their visits to see the doctor, hospitalizations, homecare nursing visits, medications, and so on.² But we now know that in Canada, a much-larger 50% of our health outcomes are dictated by environmental factors in your life outside of healthcare including your social, and economic environment.² These factors, also known as the “social determinants of health”, include a person’s income, housing, education, occupation, race, gender, access to food, and more. It was the recognition of the importance of these factors that inspired the formation of Health Providers Against Poverty (HPAP) in 2005: a group of like-minded health care providers working towards income security and social security for all.
In order to highlight the potential impacts of the election on key health issues, HPAP created a Federal Election Poverty & Health Report Card comparing the platforms of the four major parties.³ Within the health care system, four policy areas stand out to HPAP as particularly impactful. 1. Pharmacare A shocking one in five Canadians are unable to pay for their prescription medications.⁴ Universal pharmacare, a policy plank of the NDP and Green Party platforms, and one the Liberal Party promises to implement in the future, would increase access for Canadians who need it, and reduce drug costs overall for our system.⁵
2. Mental health Another gap in our current system is a lack of coverage for mental health and addictions therapy. One in five Canadians experience mental health problems every year⁶ and most will not be able to afford the therapy they need, which can cost hundreds of dollars per session. Expansion of access to mental health care has been promised by the Liberals, Green Party, and NDP, but is absent from the Conservative Party platform.
3. Dental care coverage Dental care is another aspect of our health system that is inaccessible to many. As a solution to this, both the NDP and the Green Party have proposed means-tested public dental care systems for lower income Canadians.
4. The opioid crisis The opioid crisis killed 9,000 Canadians between January 2016 and June 2018.⁷ In response, advocates are demanding a declaration of a public health emergency, implementation of a safe supply of opioids for users, decriminalization of drug possession, and a rapid scale-up of harm reduction services and addiction treatment services across Canada.³ The NDP and the Green Party have included decriminalization of drug possession; a declaration of a public health emergency; and increased treatment and harm reduction programming, while not including a promise for safe supply. The Liberal Party has earmarked addiction treatment funding of $700 million over 4 years, and promised a drug-treatment court for first time offenders, but little else. The Conservative Party platform has a $36 million investment over 3 years for inpatient treatment, but is missing everything else, and promises to cut harm reduction programming in prisons.
Where Canada’s next government can truly make the most impact on a person’s health is outside of the health system, through social policy to curb the effects of the SDOH. For example, those experiencing poverty have shorter life expectancies and are more likely to suffer from mental illness, addiction, cancer, heart disease, and diabetes.⁸ Homelessness has deleterious health effects: leading to an increase in premature death, seizures, chronic obstructive pulmonary disease, musculoskeletal disorders, tuberculosis, and skin and foot problems.⁹
As such, the policies that have the most potential to shape health outcomes include interventions into affordable housing; guaranteed liveable income; and an increase to the federal minimum wage.
Anti-poverty interventions being proposed include a federal $15/hour minimum wage in the Liberal, Green, and NDP platforms, as well as a guaranteed liveable income under the Green Party. With regards to homelessness, the Liberals, Greens, and NDP have included promises to reduce or end homelessness, and increase housing supply, whereas the Conservative Party has not included this in their platform.
On October 21, Canadians will decide who they trust to lead our country. As health care providers, we hope that the next government will consider all that can be gained for our collective health through new health care investment and social policy. With a few changes, things could look very different than they do today. Those with depression would have immediate access to publicly covered counselling; we would provide a safe home for all newcomers fleeing persecution; dental pain visits to the emergency department would be a thing of the past; HIV prevention treatment would be free for all who need it; and those who use opioids would be able to do so without constant threat of overdose.
All of this is just a vote away.
References:
² https://sencanada.ca/content/sen/Committee/392/soci/rep/rep10apr08-e.pdf
⁶ https://cmha.ca/fast-facts-about-mental-illness
⁷ https://www.canada.ca/en/public-health/news/2018/12/latest-data-on-the-opioid-crisis.html
⁸ Tjepkema, M., Wilkins, R., Long, A. (2013). Cause-specific mortality by income adequacy in Canada: A 16-year follow-up study.
